Introduction: Patients with chronic kidney disease (CKD) are
generally considered as having an increased risk for cardiovascular
events and cardiac mortality. The prognostic significance of severe
renal impairment in patients undergoing coronary revascularization
remains mainly unknown because these patients have been excluded from
randomized clinical trials. The aim of the present study was to compare
the outcome after percutaneous coronary intervention (PCI) and coronary
artery bypass grafting (CABG) in patients with an estimated glomerular
filtration rate (eGFR) <45 ml/min/m².

Methods:
This retrospective study includes 110 patients who underwent PCI and
148 patients who underwent isolated CABG between 2007 and 2010. All
patients had stage 3b to stage 5 chronic kidney disease (eGFR <45
ml/min/m²).

Results: The median follow-up time
was 26.6±18.7 months. At 30 days and five years, postoperative de novo
dialysis was required in 4.7% and 13.2% of CABG patients and in 0% and
7.1% of PCI patients. PCI was associated with significantly higher risk
of mortality (at 5 years, 56% vs. 34%, adjusted analysis: HR 1.74, 95%
CI 1.08–2.78), repeat revascularization (at 5 years, 26.3%, vs. 0.8%,
adjusted analysis: HR 16.16, 95% CI 2.01–130.15) and major adverse
cardiac and cerebrovascular events (at 5 years, 72% vs. 35%, HR 2.31,
95% CI 1.23–4.33). These findings were confirmed at propensity score
matched analysis.

Conclusion: Patients with moderate to
severe CKD have a high rate of mortality and morbidity after either PCI
or CABG. The fear of postoperative dialysis rates after CABG appears
overemphasized since only about 5% of patients needed dialysis shortly
after operation. This study provides evidence that also this high-risk
subset of patients should be revascularized according to general
recommendations. When feasible, CABG could be associated with better
survival and freedom from cardiovascular events than PCI.